Literature Review: The Use of Recruitment Maneuvers With Positive-End Expiratory Pressure (PEEP) or PEEP Alone in Reducing Morbidity in Ventilated Patients With Acute Respiratory Distress Syndrome (ARDS) and Acute Lung Injury (ALI)

Aniejurengho, C.Toritsetse, Melaundra Floyd, Frederika Robinson, and Joyce Conley

STATEMENT OF THE PROBLEM

ARDS is a sudden, life-threatening lung failure that inflames the alveoli, causing them to fill with liquid and collapse. ARDS requires treatment with mechanical ventilation or some other form of assisted breathing. The main aim of this literature review was to determine if recruitment maneuver with PEEP or PEEP alone could reduce morbidity in mechanically ventilated patients with ARDS and ALI.

 

CLINICAL QUESTION

“In the management of ventilated patients with ARDS, what is the effect of recruitment maneuver with PEEP on morbidity compared with PEEP alone?”

 

SEARCH FOR EVIDENCE

A comprehensive search of MEDLINE, CINAHL, PUBMED and Cochrane databases were completed to find articles on the clinical question. Six articles were retained for review, within the 5-year deadline. The inclusive criteria used in conducting these searches were ARDS, ALI, respiratory distress, recruitment maneuver, PEEP, mechanical ventilation, mortality and morbidity rate. Furthermore, key words, such as experimental study, randomized control trial, and clinical trial were used to set limits on this search. For studies to be retained for review, they must be evaluating the effectiveness of PEEP and/or PEEP with recruitment maneuver on patients with ARDS or ALI.

 

ACCEPTED PRACTICE

Currently there are no practices guidelines for the use of recruitment maneuver with PEEP

 

CRITICAL APPRAISAL

The majority of the studies appraised found that recruitment maneuver revealed a short-term improvement on oxygenation, but does not have an impact on long-term outcome. Recruitment maneuvers with PEEP in ARDS minimize the barotraumas in this life-threatening clinical problem.

 

CLINICAL PRACTICE IMPLICATIONS

Well-defined clinical outcomes with more robust clinical trials are required to clarify the outcome benefit of this approach. Until then, recruitment maneuvers, including PEEP, could be considered for individuals with ALI and ARDS, with the understanding that, though oxygenation may improve, there is yet no documented morbidity benefit.